不同全身麻醉药物在高龄手术患者麻醉诱导中的应用对比  

A Comparison of effectiveness of three anesthetic agents in induction of general anesthesia in elderly surgical patients

作　　者：高伟峰[1] 周浩[1] 陈策[1] 洪玲[1] 鲁银焕[1] 

机构地区：[1]浙江省慈溪市人民医院麻醉科,315300

出　　处：《中华全科医学》2015年第2期213-215,共3页Chinese Journal of General Practice

摘　　要：目的对比分析丙泊酚、咪达唑仑、依托咪酯3种全身麻醉药物在高龄手术患者麻醉诱导中的应用。方法选取2010年7月—2013年6月实施的150例手术并进行全身麻醉诱导的高龄患者为研究对象,随机分为丙泊酚组(B组)、咪达唑仑组(M组)和依托咪酯组(Y组)3组,分别给予丙泊酚、咪达唑仑和依托咪酯全麻诱导。分别监测和记录3组患者意识消失时间、睫毛反射消失时间及眼球固定时间来判断麻醉诱导显效时间,并于麻醉诱导前(T0、基础值)、诱导后插管前1 min(T1)、插管后1 min(T2)、插管后5 min(T3)、插管后10 min(T4)等5个时间点监测并记录3组患者的心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2)以评定患者循环动力学情况。结果 B组患者的意识消失时间、睫毛反射消失时间和眼球固定时间分别较M组、Y组患者显著缩短,差异有统计学意义(P<0.05),M组、Y组2组间比较无明显差异(P>0.05)。B组患者T1时HR、MAP较T0明显减慢和降低,T2时HR、MAP均较T0、T1时明显升高,差异有统计学意义(P<0.05);M组患者T2时HR、MAP均较T1时明显升高,差异有统计学意义(P<0.05);Y组患者监测过程中HR、MAP无明显变化(P>0.05)。在T0、T3、T4时3组患者HR、MAP组间比较差异无统计学意义(P>0.05);T1时HR、MAP组间比较,M组、Y组分别与B组相比明显减慢,差异有统计学意义(P<0.05),M组与Y组比较差异无统计学意义(P>0.05);T2时HR、MAP组间比较,M组、Y组分别与B组相比明显减慢或降低,差异有统计学意义(P<0.05),M组与Y组相比明显减慢或降低,差异有统计学意义(P<0.05)。结论丙泊酚、咪达唑仑、依托咪酯3种全麻诱导药物用于高龄患者全麻诱导均安全有效,其中丙泊酚显效最快,对心功能影响最大,依托咪酯和咪达唑仑显效时间接近,依托咪酯对心功能影响最小。Objective To compare the effectiveness of propofol,midazolam and etomidate in the induction of general anesthesia in elderly surgical patients. Methods A total of 150 elderly surgical patients undergoing the induction of general anesthesia in our hospital from July 2010 to June 2013 were randomly divided into three groups： propofol group（ Group B）,midazolam group（ Group M） and etomidate group（ Group Y）,which were separately given propofol,midazolam,etomidate for the induction of general anesthesia. The time for consciousness disappearance,eyelash reflex disappearance and eye fixed was monitored and recorded to determine the effective time of anesthesia induction. The heart rate（ HR）,mean arterial pressure（ MAP） and oxygen saturation（ Sp O2） of all patients were measured on the following time points： before induction of anesthesia（ T0,baseline）,between induction and 1 min before intubation（ T1）,1 min（ T2） after intubation,5min（ T3） after intubation,10 min after intubation（ T4）,the dynamics of circulation system of patients were assessed based on these data. Results The time for consciousness disappearance,eyelash reflex disappearance and eye fixed in the Group B was significantly shorter than those of Group M and Group Y,the difference was statistically significant（ P〈0. 05）,but the difference between Group M and Group Y was not statistically significant（ P〉0. 05）. In the Group B,HR and MAP at T1 was significantly slowed down than T0,but HR and MAP at T2 was significantly elevated than T0 and T1,the difference was statistically significant（ P〈0. 05）; In the Group M,HR and MAP at T2 was significantly elevated than T1,the difference was statistically significant（ P〈0. 05）; In the Group Y,HR and MAP did not change significantly during the monitoring process（ P〉0. 05）. HR and MAP at T0,T3 and T4 was no significant difference among the three groups（ P〉0. 05）; At T1,HR and MAP in the Group M and Group Y was significantly slowed down than

关 键 词：丙泊酚 依托咪酯 咪达唑仑 全身麻醉药物诱导 高龄 

分 类 号：R614.2[医药卫生—麻醉学]